Hyperpigmentation, severe alopecia, and six days of instability in a case of severe methotrexate hypersensitivity reaction

Abstract

Introduction Ectopic pregnancy (EP) is an emergency condition in the gynecologic field. Methotrexate (MTX) is a drug of choice for the medical treatment of EP. Severe adverse events are rare among patients treated with MTX for this condition. Reason for report We describe a woman with severe multi-organ involvement experiencing about six days of instability after treatment with just a single-dose MTX for EP. This life-threatening condition is not common with a single dose of MTX. Case summary A 30-year-old healthy woman was treated medically with MTX for an EP. Three days later the patient was admitted to the emergency department of our hospital with generalized pustular rashes, alopecia, hyperpigmentation, nausea and vomiting, oral ulcers, and raised Creatinine level. Four days later due to pancytopenia, fever, and loss of consciousness, she was transferred to the intensive care unit and was intubated. Outcome After 38 days of hospitalization, treatment was successful with leucovorin and supportive care and the patient's symptoms and clinical manifestations were regressed.

Severe Adverse Toxic Effects of Low-Dose Methotrexate Treatment on an Ectopic Pregnancy Patient With Methylenetetrahydrofolate Reductase Mutations: A Case Report

“…LD-MTX can interfere with the DNA synthesis and inhibit proliferation of trophoblasts, preventing embryonic development, and it may lead to absorption ( 1 , 16 ). To date, only eight cases, including the present one, of single-dose LD-MTX protocols that induced serious adverse toxic effects on patients with EP have been reported ( Table 2 ) ( 10 , 19 – 24 ).…”

“…In this case, the serum MTX concentration was still higher than the aforementioned threshold after 4 days of CF rescue with 20 mg, IV q6h, thus, the dose of CF was elevated to 100 mg, IV q6h. However, Shiver et al pointed that serum MTX concentration is a poor indicator of intracellular toxicity, because MTX is retained in toxic amounts in the polyglutamated form within the cells ( 6 , 19 ). The status of the patient investigated in this report also confirmed the mentioned finding, in which rescue measures should be taken independent of serum MTX concentration.…”

Low-dose methotrexate-induced renal failure in a patient with ectopic pregnancy: a case report

“…To date, only 9 cases of single-dose LD-MTX protocols that induced serious adverse toxic effects on patients with EP have been reported [ 5 ]. In the 10 cases including ours, all the patients had myelosuppression [ 11 – 18 ] most of them had nausea and vomiting, All the 9 patients had fever except our case. 2 patients had septic shock [ 11 , 14 ], 3 patients had liver injury [ 14 , 15 , 18 ], 2 patients including our case had renal failure [ 18 ] and 3 patients died [ 14 , 15 , 18 ].…”

Status and strategies of college English teaching using adaptive deep learning from the perspective of multiculturalism

“…Non-negative Matrix Factorization (NMF) is an effective DL method to find more non-negative matrices to make the final product as close to the original matrix as possible. It realizes the non-linear dimensionality reduction of the data ( Wu et al, 2020 ; Shafie et al, 2021 ). The calculation of the norm cost function by the matrix difference is expressed in Equation (4) .…”